EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy
EEG-fMRI in the presurgical evaluation of temporal lobe epilepsy
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DOI：
10.1136/jnnp-2015-310401
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发表时间：
2016-06-01
影响因子：
11
通讯作者：
Lemieux, Louis
中科院分区：
文献类型：
--
作者：
Coan, Ana C.;Chaudhary, Umair J.;Lemieux, Louis
目的对耐药性颞叶癫痫（TLE）进行彻底的检查，以确定致痫灶，为手术治疗提供依据。我们同时使用发作间期头皮EEG-fMRI评估其价值预测长期postsurgical outcome.Methods 30例患者接受术前评估和进行颞叶（TL）切除术进行了研究。发作间期癫痫样放电（IEDs）被确定为内MRI脑电图，并用于建立一个模型的血流动力学变化。此外，地形脑电图相关图之间的平均IED在videoEEG和intra-MRI EEG计算，并作为一个条件。这允许对所有数据进行分析，无论MRI内EEG上是否存在IED。术后平均随访46个月。国际抗癫痫联盟（ILAE）结局1和2被认为是良好，3-6被认为是差的手术结局。血流动力学图根据是否存在（一致）或缺失与手术切除重叠的TL患者的血氧水平依赖性（BOLD）变化（不一致）。结果手术效果良好的患者比例明显高于手术切除的患者一致组（13/16; 81%）高于不一致组（3/14; 21%）（卡方检验，耶茨校正，p=0.003）和多变量分析显示，一致BOLD标测图与良好手术结局独立相关（p=0.007）。EEG-fMRI结果的敏感性和特异性，以确定良好的手术效果的患者分别为81%和79%，阳性和阴性预测值分别为81%和79%，respectively.Interpretation的存在下，在该地区的切除发作间期的EEG-fMRI患者回顾性确认癫痫区。手术切除包括TL的血流动力学变化区域可能会导致更好的术后结局。
Objective Drug-resistant temporal lobe epilepsy (TLE) often requires thorough investigation to define the epileptogenic zone for surgical treatment. We used simultaneous interictal scalp EEG-fMRI to evaluate its value for predicting long-term postsurgical outcome.Methods 30 patients undergoing presurgical evaluation and proceeding to temporal lobe (TL) resection were studied. Interictal epileptiform discharges (IEDs) were identified on intra-MRI EEG and used to build a model of haemodynamic changes. In addition, topographic electroencephalographic correlation maps were calculated between the average IED during videoEEG and intra-MRI EEG, and used as a condition. This allowed the analysis of all data irrespective of the presence of IED on intra-MRI EEG. Mean follow-up after surgery was 46 months. International League Against Epilepsy (ILAE) outcomes 1 and 2 were considered good, and 3-6 poor, surgical outcome. Haemodynamic maps were classified according to the presence (Concordant) or absence (Discordant) of Blood Oxygen Level-Dependent (BOLD) change in the TL overlapping with the surgical resection.Results The proportion of patients with good surgical outcome was significantly higher (13/16; 81%) in the Concordant than in the Discordant group (3/14; 21%) (chi(2) test, Yates correction, p=0.003) and multivariate analysis showed that Concordant BOLD maps were independently related to good surgical outcome (p=0.007). Sensitivity and specificity of EEG-fMRI results to identify patients with good surgical outcome were 81% and 79%, respectively, and positive and negative predictive values were 81% and 79%, respectively.Interpretation The presence of significant BOLD changes in the area of resection on interictal EEG-fMRI in patients with TLE retrospectively confirmed the epileptogenic zone. Surgical resection including regions of haemodynamic changes in the TL may lead to better postoperative outcome.